Provider Demographics
NPI:1083014203
Name:KELLER, TAMI
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8784 PERRY LONG CT
Mailing Address - Street 2:
Mailing Address - City:KEMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:19529-8922
Mailing Address - Country:US
Mailing Address - Phone:610-972-0964
Mailing Address - Fax:
Practice Address - Street 1:8784 PERRY LONG CT
Practice Address - Street 2:
Practice Address - City:KEMPTON
Practice Address - State:PA
Practice Address - Zip Code:19529-8922
Practice Address - Country:US
Practice Address - Phone:610-972-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002508225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant